Individual
TIMOTHY SCOTT TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9825 KENWOOD RD STE 105, BLUE ASH, OH 45242-6252
(513) 872-4500
(513) 527-0416
Mailing address
2624 WENDELL AVE, LOUISVILLE, KY 40205-3138
(502) 558-2689
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
35133381
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0280677
—
OH
01
—
G529780
MEDICARE OHIO
OH
Enumeration date
05/23/2012
Last updated
06/16/2018
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